Sunday 9.29.13

What is Rhabdomyolysis ('Rhabdo' for short) and how do you prevent it.

Among the things that upset CrossFit "haters" is this image they used in an article to get people's attention

Many of us recently read an article called “Crossfit’s Dirty Little Secret.”

Among the things that bothered me, was one paragraph that stated:

"And here we have arrived at CrossFit’s dirty little secret. The coach was unusually familiar with what is normally a very rarely seen disorder. It’s so rare that one study reported the overall annual incidence of rhabdomyolysis to be 0.06%. That represents single digits of cases out of hundreds of thousands of patients. How, I wondered, is it possible that the layperson exercise instructor is on a first-name basis with a serious, yet rare medical condition? Is this a thing with CrossFit? It turns out it is."

The funny thing is, is that CrossFit has never kept rhabdomyolysis a secret.  CrossFit has always been about educating the general public, something that no other sport or physical fitness regimen has done.  So back in 2005, they educated the Crossfit Community in several articles in the CrossFit Journal.  Since then, everyone that attends a CrossFit Level 1 Certification is taught about Rhabdo.  This means that everyone has now been introduced to CrossFit potentially is aware of Rhabdo.  This does not make it a "thing" with CrossFit.  It makes for a more aware clientele.

So let's learn about it:

What is it?

Rhabdomyolysis (RAB-DOE-MY-O-LIE-SIS) is the rapid destruction of skeletal muscle resulting in leakage into the urine of the muscle protein myoglobin.

What causes rhabdomyolysis?

Rhabdomyolysis has many causes. Some of the common ones include (from MedicineNet.com):

• muscle trauma or crush injury,
• medications: most notably statins used to treat high cholesterol [simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol), or lovastatin (Mevacor)] and other medications such as Parkinson's medication, psychiatric medications, anesthesia medications, HIV medications, colchicine,
• prolonged lying down on the ground (people who fall or are unconscious and are unable to get up for several hours),
• extreme physical activity (running a marathon),
• Many others listed at MedicineNet.com

What are the symptoms of rhabdomyolysis?

Rhabdomyolysis may not cause any symptoms at all (mild case). Muscle aches and pain (myalgia), stiffness, and muscle weakness can occur with rhabdomyolysis, and is especially common with severe muscle damage. Rhabdomyolysis may cause a darkening of the urine color. Myoglobin is released from the muscles when they break down and is excreted into the urine. This can cause a red or cola color of the urine.

How is rhabdomyolysis treated?

The treatment of rhabdomyolysis depends on its cause and severity.  If a cause for rhabdomyolysis is identified, it is addressed; for example:

• discontinuing a toxic medication,
• replacing electrolytes, or
• treating an underlying muscle disease.

In cases of mild rhabdomyolysis without any evidence of complications, management can take place at home by simply recognizing the cause and correcting it, such as discontinuing a medication and re-hydration.  In more severe cases, or if home therapy is not possible, hospitalization may be required.

So, how do we prevent it?

It's already taken care of in everything CrossFit teaches.  Start of slowly, like we do at the Compound with CompoundLite and Elements classes.  Don't go too intense too many days in a row.  CrossFit teaches 3 days on, 1 day off.  At the Compound, we have always suggested taking a day off in the middle of the week AND Sunday.

Here are some other things to look out for as a potential for Rhabdo:

- Training more than 3-4 days in a row at high intensity

- Using weights that are too heavy for your strength/form level

- Not drinking enough water

- Letting your ego dictate your pace and not your ability

- Ignoring pains and not addressing the root cause of the injuries

- Not taking rest days and rest weeks

- ‘Competing’ too often (in the gym or outside competitions)

- Neglecting skills/ movements that you suck at or can’t do

- Doing too much Metcon and not enough of everything else (skills, strength, mobility, rest, etc)

Examples outside of the gym:

- Not getting enough good sleep

- Eating copious amounts of high inflammatory/ processed foods

- eating/drinking crap

- Not taking care of your body mobility wise (posture, sitting, etc)

It's funny, I read once where the people who are most likely to get Rhabdo are the High School/ College athletes 5 - 10 years removed who still think they are in the same shape as they were back then.  The one's who were ultra competitive back in High School and still think they can dust off the wrestling singlet and throw it on and not get hurt wrestling.

I was one of those guys.  When I started CrossFit 7-8 years ago, I did a WOD for 3 days AFTER my hour and a half bodybuilding style weightlifting session.  I go back and look at my workout notes and the 3-4 days after that, I noted that I was sick.  I am sure I had a mild case of Rhabdo, without knowing it.  I learned from that and quickly changed my training to just CrossFit, so that wouldn't happen to my body again.

I have been away from the gym sick for several days now.  But you can bet when I return to the gym, I won't go all out like I am at peak fitness until I can ramp my body back into training intensely.  That's another way I plan on preventing Rhabdo.